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Job Ref.: 4197

Job Title: Denials Prevention Supervisor

Role: Nursing or Physician and other healthcare related opportunities

Relocation Available: No

Industry: Healthcare

Location: Ohio

Town / City: Cincinnati area

Job Type: Permanent full-time

Job description:

Position Summary: Primarily responsible for leadership and management of the daily workflow of the Denial Prevention team.
 
General Purpose: Leadership; management; employee and client relations; problem solving resolution; critical thinking; auditing; relationship and team building
 
Essential Duties and Responsibilities:
 
Interview, hire, train, audit and review team members
Lead, supervise, motivate and monitor team members to ensure compliance with policies, procedures and standards
Advise Manager of any workflow, personnel, client or carrier issues or improvement opportunities both within the department and in other operational departments
Support and assist team members with difficult issues concerning work, co-workers, clients and/or carriers; offer suggestions to assist in process of underpayment reviews and collections
Ensure team successfully achieves quality, productivity and collection goals
Participate in workflow examination or special projects as directed by management
Track various departmental information in order to develop and maintain benchmarks, create goals, manage trends, identify areas of opportunity and weakness, identify issues and training opportunities
Collect, track, and analyze various client-requested data and reports to identify trends, process improvements, and best practice recommendations
Assist in and/or lead presenting and feeding back to the client the results and recommendations during executive summaries and working sessions
Build strong, lasting relationships with the staff, the management team, and other internal and external clients
Maintain regular contact with necessary parties regarding claims status including carriers, clients, managers and other personnel
Organize, prepare and/or attend department, client and company meetings
Investigate various issues with carriers and their contracts; respond to questions and resolve problems
Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting
Perform duties and responsibilities of Project Coordinator, Lead Analyst or Analyst as needed and instructed by the Manager
Attend client, department and company meetings
Comply with federal and state laws, company policies and procedures
Other duties as assigned
 
Essential Skills and Experience:
 
Minimum of 5-years denials claims experience and/or training
High school diploma or equivalent
Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook
Analytical and problem solving skills
Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division
Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form
Ability to write routine correspondence (in English)
Ability to define problems, collect data, establish facts and draw valid conclusions
Strong customer service orientation
Excellent interpersonal and communication skills
Excellent leadership skills and abilities
Strong team player
Ability to work on own with minimal supervision and use effective time management skills to complete tasks on time
Commitment to company values
Ability to travel by automobile or public transportation to visit or setup work sites

Bottom Line Requirements:

1. 5+ years of denials claims experience or training including hospital revenue cycle claims.
2. High school diploma or equivalent.
3. Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook.
4. Strong leadership skills.

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